Caring for Our Children (CFOC)

Chapter 7: Infectious Diseases

7.1 Infections in Early Care and Education Programs

After reading the CFOC chapter introduction, see COVID-19 modification below (Also consult  applicable state licensure and public health requirements).

Infants and young children who attend early care and education programs are at a high risk for catching and spreading infections for several reasons, including:1–2

  • Exposure to germs, often for the first time
  • Behaviors that could spread germs to other children, staff, and family members. For example:
    • Sneezing and poor cough etiquette (e.g., coughing into a bare hand)
    • Not washing hands properly, enough, or at all
    • Touching contaminated surfaces and objects
    • Touching eyes, nose, or mouth with unwashed hands
    • Children putting shared toys in their mouths 
    • Diapering and toileting accidents
    • Improper food handling
    • Ineffective cleaning, sanitizing, or disinfecting of surfaces
    • Children or staff who are not up to date on their immunizations
  • Poor ventilation and air filtration 

Germs in early care and education programs are spread through different ways.1–2

  • Direct contact: Germs spread from one person to another by physical contact (e.g., touching). 
  • Indirect contact: Germs spread from a contaminated surface or object (e.g., toy, table, toilet seat) to a person.
  • Droplets: Germs from respiratory infections (e.g., colds, influenza) can be spread by droplets in the air when someone talks, coughs, or sneezes on a person or object, or spread on surfaces when an infected person touches an object (e.g., toys, table) with dirty hands or mucus.
  • Airborne: Germs from infections (e.g., chicken pox, measles) that stay in and travel through the air can be inhaled. 
  • Feces: Germs from stool infections (e.g., rotavirus, giardia, hepatitis A) can be spread through toileting surfaces (e.g., diapers, toilets, changing tables, sinks, floors, hands) when stool gets into the mouth. 
  • Blood, saliva, urine: Germs from infected blood (e.g., hepatitis B, HIV), saliva, or urine (e.g., cytomegalovirus) can spread when blood, saliva, or urine is transferred from one person to another (e.g., through an open wound, mouth, or eyes).

Early care and education programs can reduce infectious disease spread by:2

  • Staying up to date with child and adult immunizations
  • Developing written policies about proper cleaning, sanitizing, and disinfecting
  • Training staff regularly on infection control practices
  • Practicing proper and frequent hand hygiene 
  • Practicing good sneeze/cough etiquette 
  • Practicing safe food handling 
  • Cleaning, sanitizing, and/or disinfecting surfaces and objects
  • Using recommended ventilation practices and heating, ventilation, and air conditioning (HVAC) maintenance
  • Performing daily staff and child health checks
  • Developing and enforcing clear policies for when sick children and staff need to stay home
  • Partnering with a child care health consultant to review infection control practices, as available3
COVID-19 modification as of July 28, 2023: 

According to Centers for Disease Control and Prevention (CDC), COVID-19 is a respiratory disease caused by SARS-CoV-2, a new coronavirus discovered in 2019 causing the current pandemic. The virus is thought to spread mainly from person to person through respiratory droplets produced when an infected person coughs, sneezes, breathes, talks or sings. Airborne virus particles can remain suspended in the air and breathed in, and travel distances greater than 6 feet.

Some people who are infected may not have symptoms. For people who have symptoms, illness can range from mild to severe. Adults 65 years and older and people of any age with underlying medical conditions are at higher risk for severe illness.

The following risk reduction strategies are recommended to help decrease the spread of the virus:

  • Wash your hands
  • Wearing a well-fitting mask
  • Increase fresh air
  • Clean and disinfect
  • Stay home when sick
  • Get vaccinated
  • Get tested if you are experiencing symptoms
  • Refer to the complete list Symptoms of COVID-19 | CDC

Early childhood programs should follow local and national guidance during the COVID-19 pandemic.

Additional Resources:

Centers for Disease Control and Prevention

Early Childhood Learning and Knowledge Center (ECLKC). COVID-19 Risk Reduction Strategies: Posters


Child care health consultants are a good resource for more information on infectious diseases. Also, reviewing policies or situations specific to a program as they come up, and consulting with local public health departments and jurisdictions can be helpful. Local guidance may change during an outbreak or pandemic.

More information about reducing infectious diseases in early care and education programs may be found at:

  1. American Academy of Pediatrics. Section 2: Recommendation for care of children in special circumstances; children in group childcare and schools. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2021:116126
  2. American Academy of Pediatrics. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. Aronson SS, Shope TR, eds. 5th ed. Itasca, IL: American Academy of Pediatrics; 2020
  3. Johnston R, DelConte B, Ungvary L, Fiene R, Aronson S. Child care health consultation improves infant and toddler care. J Pediatr Health Car. 2017;31(6):684694. doi:10.1016/j.pedhc.2017.05.005
Content in the standard was modified on 7/05/2022.